Nasogastric (NG) feeding tubes are commonly inserted to supplement enteral nutrition in certain patient groups, including those with head and neck cancers where swallowing may be compromised. An NHS National Patient Safety Alert was released in 2011 detailing ongoing cases of significant morbidity and mortality attached to the incorrect placement of NG feeding tubes in hospital inpatients. Since 2005, there were 21 deaths and 79 cases of harm nationally due to feeding into the lung through misplaced tubes. pH testing remains the first-line method of placement confirmation, with chest x-ray used when no aspirate is gained or where pH testing fails to confirm suitable acidity. We present a case report describing false-positive NG tube placement confirmation tests in a patient with head and neck cancer, who was administered feed into lung parenchyma with significant morbidity. We discuss the case for specific NG tube placement protocols in head and neck cancer patients.

The cerebellum is central to normal motor function and co-ordination, and can be frequently affected in a number of common disease processes. However, medical student teaching relating to cerebellar anatomy and pathology is lacking, leaving many graduates with a significant knowledge gap. Junior doctors need to be able to recognize ‘cerebellar syndromes’ on presentation to hospitals, and to identify and manage reversible causes rapidly and effectively. After review of relevant literature, a simple approach to the functional anatomy and practical classifications of common cerebellar pathology is presented here, with a focus on symptoms, signs and examination techniques essential to medical school final exams.